A new synthetic brain simulator for endoscopic third ventriculostomy.

Breimer, G.E. (Gerben Eise) (2013) A new synthetic brain simulator for endoscopic third ventriculostomy. thesis, Medicine.

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Abstract

Introduction: Endoscopic third ventriculostomy (ETV) is an effective but technically demanding procedure with significant risk. Current simulators include human cadavers, animal models and virtual reality (VR) systems, however there are drawbacks. Human cadavers are expensive and relatively inaccessible; animal models do not represent the condition accurately; and VR systems are expensive and lack realistic sensory feedback. We have constructed a realistic low cost, reusable brain simulator for ETV, evaluated it for fidelity, and used it to differentiate levels of surgical skill by means of an ETV assessment tool, which was constructed as part of this study. Methods: A silicone-based brain simulator mimicking the normal mechanical properties of a four-month-old child with hydrocephalus was constructed, encased in the replicated skull and immersed in water. The thinned out third ventricle floor, which dissected realistically, was made to be replaceable. Bleeding scenarios were also incorporated. The simulator was tested for fidelity by means of a questionnaire completed by sixteen neurosurgical trainees (PGY 1-6) and nine pediatric and adult neurosurgeons. The Delphi method was used to reach consensus among seventeen international experts on a series of ETV assessment tools: a procedural checklist, a checklist of potential errors and a global rating scale. Performance of novices, senior residents and neurosurgeons were compared using the validated ETV assessment tool. Results: The simulator was portable, robust, and able to be set up in minutes. Over 95 % of participants agreed or strongly agreed that the simulator’s anatomical features, tissue properties, and bleeding scenarios were a realistic representation of that seen during an ETV. Participants stated that the simulator helped develop the required hand-eye coordination and camera skills, and was a valuable training exercise. Three assessment tools were created in order to evaluate surgical competence with ETV. Using the objective measures of the ETV assessment tool, neurosurgeons scored significantly higher than novices on the simulator. Conclusion: A low-cost, reusable silicone-based ETV simulator realistically represents the surgical procedure to trainees and neurosurgeons. It can develop the technical and cognitive skills for ETV, including dealing with complications. In addition, an assessment tool with content validity was designed as a standardized method to evaluate a trainee’s competence with ETV.

Item Type:	Thesis (Thesis)
Supervisor name:	Hoving, Dr. E.W.
Supervisor name:	Drake, Prof. Dr. J.M. and The Hospital for Sick Children and Toronto, Canada
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:57
Last Modified:	25 Jun 2020 10:57
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1744

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